Revisiting the Debate of ‘Routine’ vs ‘Selective’ Microscopic Evaluation of Cholecystectomies: Observations from an Indian Archipelago on the Incidence of Dysplasia and Incidental Gallbladder Cancer

Background: Gallstone disease or cholelithiasis is a common indication for cholecystectomy globally, with various histopathological alterations in gallbladder mucosa. Understanding these changes is crucial for determining their relationship with gall bladder cancer and justifying histopathological examination policies. In this context, this study was undertaken to investigate the range of histomorphological abnormalities found in gall bladder specimens removed for cholelithiasis. Additionally, the study seeks to establish the prevalence of dysplasia and incidental gall bladder cancer in these specimens. Materials and Methods: A retrospective study spanning five years was conducted at a tertiary care hospital. Demographic data, macroscopic features, and histopathological findings of all cholecystectomy specimens were recorded and analyzed. Results: Among 1,380 patients, chronic cholecystitis (75.3%) was most common, followed by cholesterolosis (17.9%) and xanthogranulomatous cholecystitis (1.7%). Only two cases (0.14%) of gallbladder cancer were found. Low-grade dysplasia was present in 0.9% of cases. No cases of incidental gallbladder cancer were encountered. Conclusion: Chronic cholecystitis predominates in cholecystectomy specimens for cholelithiasis in our setting, with low rates of neoplastic pathology. The absence of incidental gallbladder cancer in the study favors selective over routine histopathological examination. However, further validation studies and cost-benefit analyses are needed to form evidence-based guidelines regarding the policy of selective histopathological examination of resected gallbladder specimens in the Indian setup.